H.B. 24 Autism Insurance Coverage Sunset Amendments
| Bill Sponsor:  Rep. Ray, Paul | Floor Sponsor:  Sen. Bramble, Curtis S. |
- Drafting Attorney: Daniel M. Cheung
- Fiscal Analyst: Andrea Wilko
- Bill Text
- Introduced
- Enrolled (Currently Displayed)
- Introduced
- Related Documents
- Information
- Last Action: 19 Mar 2018, Governor Signed
- Last Location: Lieutenant Governor's office for filing
- Effective Date: 8 May 2018
- Session Law Chapter: 183
- Committee Note: The Health and Human Services Interim Committee recommended this bill. (--)
- Similar Bills
- Sections Affected
Enrolled
Printer FriendlyH.B. 24
1 AUTISM INSURANCE COVERAGE SUNSET AMENDMENTS
22018 GENERAL SESSION
3STATE OF UTAH
4Chief Sponsor: Paul Ray
5Senate Sponsor: Curtis S. Bramble
6
7 LONG TITLE
8 General Description:
9 This bill removes the repeal date of statutory provisions for insurance coverage of
10 autism spectrum disorder.
11 Highlighted Provisions:
12 This bill:
13 ▸ removes the repeal date of statutory provisions for insurance coverage of autism
14 spectrum disorder.
15 Money Appropriated in this Bill:
16 None
17 Other Special Clauses:
18 None
19 Utah Code Sections Affected:
20 AMENDS:
21 31A-22-642, as last amended by Laws of Utah 2017, Chapter 292
22 63I-1-231, as last amended by Laws of Utah 2017, Chapters 53 and 181
23
24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 31A-22-642 is amended to read:
26 31A-22-642. Insurance coverage for autism spectrum disorder.
27 (1) As used in this section:
28 (a) "Applied behavior analysis" means the design, implementation, and evaluation of
29 environmental modifications, using behavioral stimuli and consequences, to produce socially
30 significant improvement in human behavior, including the use of direct observation,
31 measurement, and functional analysis of the relationship between environment and behavior.
32 (b) "Autism spectrum disorder" means pervasive developmental disorders as defined
33 by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
34 (DSM).
35 (c) "Behavioral health treatment" means counseling and treatment programs, including
36 applied behavior analysis, that are:
37 (i) necessary to develop, maintain, or restore, to the maximum extent practicable, the
38 functioning of an individual; and
39 (ii) provided or supervised by a:
40 (A) board certified behavior analyst; or
41 (B) person licensed under Title 58, Chapter 1, Division of Occupational and
42 Professional Licensing Act, whose scope of practice includes mental health services.
43 (d) "Diagnosis of autism spectrum disorder" means medically necessary assessments,
44 evaluations, or tests:
45 (i) performed by a licensed physician who is board certified in neurology, psychiatry,
46 or pediatrics and has experience diagnosing autism spectrum disorder, or a licensed
47 psychologist with experience diagnosing autism spectrum disorder; and
48 (ii) necessary to diagnose whether an individual has an autism spectrum disorder.
49 (e) "Pharmacy care" means medications prescribed by a licensed physician and any
50 health-related services considered medically necessary to determine the need or effectiveness
51 of the medications.
52 (f) "Psychiatric care" means direct or consultative services provided by a psychiatrist
53 licensed in the state in which the psychiatrist practices.
54 (g) "Psychological care" means direct or consultative services provided by a
55 psychologist licensed in the state in which the psychologist practices.
56 (h) "Therapeutic care" means services provided by licensed or certified speech
57 therapists, occupational therapists, or physical therapists.
58 (i) "Treatment for autism spectrum disorder":
59 (i) means evidence-based care and related equipment prescribed or ordered for an
60 individual diagnosed with an autism spectrum disorder by a physician or a licensed
61 psychologist described in Subsection (1)(d) who determines the care to be medically necessary;
62 and
63 (ii) includes:
64 (A) behavioral health treatment, provided or supervised by a person described in
65 Subsection (1)(c)(ii);
66 (B) pharmacy care;
67 (C) psychiatric care;
68 (D) psychological care; and
69 (E) therapeutic care.
70 (2) Notwithstanding the provisions of Section 31A-22-618.5, a health benefit plan
71 offered in the individual market or the large group market and entered into or renewed on or
72 after January 1, 2016, shall provide coverage for the diagnosis and treatment of autism
73 spectrum disorder:
74 (a) for a child who is at least two years old, but younger than 10 years old; and
75 (b) in accordance with the requirements of this section and rules made by the
76 commissioner.
77 (3) The commissioner may adopt rules in accordance with Title 63G, Chapter 3, Utah
78 Administrative Rulemaking Act, to set the minimum standards of coverage for the treatment of
79 autism spectrum disorder.
80 (4) Subject to Subsection (5), the rules described in Subsection (3) shall establish
81 durational limits, amount limits, deductibles, copayments, and coinsurance for the treatment of
82 autism spectrum disorder that are similar to, or identical to, the coverage provided for other
83 illnesses or diseases.
84 (5) (a) Coverage for behavioral health treatment for a person with an autism spectrum
85 disorder shall cover at least 600 hours a year. Other terms and conditions in the health benefit
86 plan that apply to other benefits covered by the health benefit plan apply to coverage required
87 by this section.
88 (b) Notwithstanding Section 31A-45-303, a health benefit plan providing treatment
89 under Subsection (5)(a) shall include in the plan's provider network both board certified
90 behavior analysts and mental health providers qualified under Subsection (1)(c)(ii).
91 (6) A health care provider shall submit a treatment plan for autism spectrum disorder to
92 the insurer within 14 business days of starting treatment for an individual. If an individual is
93 receiving treatment for an autism spectrum disorder, an insurer shall have the right to request a
94 review of that treatment not more than once every six months. A review of treatment under
95 this Subsection (6) may include a review of treatment goals and progress toward the treatment
96 goals. If an insurer makes a determination to stop treatment as a result of the review of the
97 treatment plan under this subsection, the determination of the insurer may be reviewed under
98 Section 31A-22-629.
99 (7) (a) In accordance with Subsection (7)(b), the commissioner shall waive the
100 requirements of this section for all insurers in the individual market or the large group market,
101 if an insurer demonstrates to the commissioner that the insurer's entire pool of business in the
102 individual market or the large group market has incurred claims for the autism coverage
103 required by this section in a 12 consecutive month period that will cause a premium increase
104 for the insurer's entire pool of business in the individual market or the large group market in
105 excess of 1% over the insurer's premiums in the previous 12 consecutive month period.
106 (b) The commissioner shall waive the requirements of this section if:
107 (i) after a public hearing in accordance with Title 63G, Chapter 4, Administrative
108 Procedures Act, the commissioner finds that the insurer has demonstrated to the commissioner
109 based on generally accepted actuarial principles and methodologies that the insurer's entire pool
110 of business in the individual market or the large group market will experience a premium
111 increase of 1% or greater as a result of the claims for autism services as described in this
112 section; or
113 (ii) the attorney general issues a legal opinion that the limits under Subsection (5)(a)
114 cannot be implemented by an insurer in a manner that complies with federal law.
115 (8) If a waiver is granted under Subsection (7), the insurer may:
116 (a) continue to offer autism coverage under the existing plan until the next renewal
117 period for the plan, at which time the insurer:
118 (i) may delete the autism coverage from the plan without having to re-apply for the
119 waiver under Subsection (7); and
120 (ii) file the plan with the commissioner in accordance with guidelines issued by the
121 commissioner;
122 (b) discontinue offering plans subject to Subsection (2), no earlier than the next
123 calendar quarter following the date the waiver is granted, subject to filing guidelines issued by
124 the commissioner; or
125 (c) nonrenew existing plans that are subject to Subsection (2), in compliance with
126 Subsection 31A-22-618.6(5) or Subsection 31A-22-618.7(3).
127 [(9) This section sunsets in accordance with Section 63I-1-231.]
128 Section 2. Section 63I-1-231 is amended to read:
129 63I-1-231. Repeal dates, Title 31A.
130 (1) Section 31A-2-217, Coordination with other states, is repealed July 1, 2023.
131 (2) Section 31A-22-615.5 is repealed July 1, 2022.
132 (3) Section 31A-22-619.6, Coordination of benefits with workers' compensation
133 claim--Health insurer's duty to pay, is repealed on July 1, 2018.
134 [(4) Section 31A-22-642, Insurance coverage for autism spectrum disorder, is repealed
135on January 1, 2019.]
2
3
4
5
6
7 LONG TITLE
8 General Description:
9 This bill removes the repeal date of statutory provisions for insurance coverage of
10 autism spectrum disorder.
11 Highlighted Provisions:
12 This bill:
13 ▸ removes the repeal date of statutory provisions for insurance coverage of autism
14 spectrum disorder.
15 Money Appropriated in this Bill:
16 None
17 Other Special Clauses:
18 None
19 Utah Code Sections Affected:
20 AMENDS:
21 31A-22-642, as last amended by Laws of Utah 2017, Chapter 292
22 63I-1-231, as last amended by Laws of Utah 2017, Chapters 53 and 181
23
24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 31A-22-642 is amended to read:
26 31A-22-642. Insurance coverage for autism spectrum disorder.
27 (1) As used in this section:
28 (a) "Applied behavior analysis" means the design, implementation, and evaluation of
29 environmental modifications, using behavioral stimuli and consequences, to produce socially
30 significant improvement in human behavior, including the use of direct observation,
31 measurement, and functional analysis of the relationship between environment and behavior.
32 (b) "Autism spectrum disorder" means pervasive developmental disorders as defined
33 by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
34 (DSM).
35 (c) "Behavioral health treatment" means counseling and treatment programs, including
36 applied behavior analysis, that are:
37 (i) necessary to develop, maintain, or restore, to the maximum extent practicable, the
38 functioning of an individual; and
39 (ii) provided or supervised by a:
40 (A) board certified behavior analyst; or
41 (B) person licensed under Title 58, Chapter 1, Division of Occupational and
42 Professional Licensing Act, whose scope of practice includes mental health services.
43 (d) "Diagnosis of autism spectrum disorder" means medically necessary assessments,
44 evaluations, or tests:
45 (i) performed by a licensed physician who is board certified in neurology, psychiatry,
46 or pediatrics and has experience diagnosing autism spectrum disorder, or a licensed
47 psychologist with experience diagnosing autism spectrum disorder; and
48 (ii) necessary to diagnose whether an individual has an autism spectrum disorder.
49 (e) "Pharmacy care" means medications prescribed by a licensed physician and any
50 health-related services considered medically necessary to determine the need or effectiveness
51 of the medications.
52 (f) "Psychiatric care" means direct or consultative services provided by a psychiatrist
53 licensed in the state in which the psychiatrist practices.
54 (g) "Psychological care" means direct or consultative services provided by a
55 psychologist licensed in the state in which the psychologist practices.
56 (h) "Therapeutic care" means services provided by licensed or certified speech
57 therapists, occupational therapists, or physical therapists.
58 (i) "Treatment for autism spectrum disorder":
59 (i) means evidence-based care and related equipment prescribed or ordered for an
60 individual diagnosed with an autism spectrum disorder by a physician or a licensed
61 psychologist described in Subsection (1)(d) who determines the care to be medically necessary;
62 and
63 (ii) includes:
64 (A) behavioral health treatment, provided or supervised by a person described in
65 Subsection (1)(c)(ii);
66 (B) pharmacy care;
67 (C) psychiatric care;
68 (D) psychological care; and
69 (E) therapeutic care.
70 (2) Notwithstanding the provisions of Section 31A-22-618.5, a health benefit plan
71 offered in the individual market or the large group market and entered into or renewed on or
72 after January 1, 2016, shall provide coverage for the diagnosis and treatment of autism
73 spectrum disorder:
74 (a) for a child who is at least two years old, but younger than 10 years old; and
75 (b) in accordance with the requirements of this section and rules made by the
76 commissioner.
77 (3) The commissioner may adopt rules in accordance with Title 63G, Chapter 3, Utah
78 Administrative Rulemaking Act, to set the minimum standards of coverage for the treatment of
79 autism spectrum disorder.
80 (4) Subject to Subsection (5), the rules described in Subsection (3) shall establish
81 durational limits, amount limits, deductibles, copayments, and coinsurance for the treatment of
82 autism spectrum disorder that are similar to, or identical to, the coverage provided for other
83 illnesses or diseases.
84 (5) (a) Coverage for behavioral health treatment for a person with an autism spectrum
85 disorder shall cover at least 600 hours a year. Other terms and conditions in the health benefit
86 plan that apply to other benefits covered by the health benefit plan apply to coverage required
87 by this section.
88 (b) Notwithstanding Section 31A-45-303, a health benefit plan providing treatment
89 under Subsection (5)(a) shall include in the plan's provider network both board certified
90 behavior analysts and mental health providers qualified under Subsection (1)(c)(ii).
91 (6) A health care provider shall submit a treatment plan for autism spectrum disorder to
92 the insurer within 14 business days of starting treatment for an individual. If an individual is
93 receiving treatment for an autism spectrum disorder, an insurer shall have the right to request a
94 review of that treatment not more than once every six months. A review of treatment under
95 this Subsection (6) may include a review of treatment goals and progress toward the treatment
96 goals. If an insurer makes a determination to stop treatment as a result of the review of the
97 treatment plan under this subsection, the determination of the insurer may be reviewed under
98 Section 31A-22-629.
99 (7) (a) In accordance with Subsection (7)(b), the commissioner shall waive the
100 requirements of this section for all insurers in the individual market or the large group market,
101 if an insurer demonstrates to the commissioner that the insurer's entire pool of business in the
102 individual market or the large group market has incurred claims for the autism coverage
103 required by this section in a 12 consecutive month period that will cause a premium increase
104 for the insurer's entire pool of business in the individual market or the large group market in
105 excess of 1% over the insurer's premiums in the previous 12 consecutive month period.
106 (b) The commissioner shall waive the requirements of this section if:
107 (i) after a public hearing in accordance with Title 63G, Chapter 4, Administrative
108 Procedures Act, the commissioner finds that the insurer has demonstrated to the commissioner
109 based on generally accepted actuarial principles and methodologies that the insurer's entire pool
110 of business in the individual market or the large group market will experience a premium
111 increase of 1% or greater as a result of the claims for autism services as described in this
112 section; or
113 (ii) the attorney general issues a legal opinion that the limits under Subsection (5)(a)
114 cannot be implemented by an insurer in a manner that complies with federal law.
115 (8) If a waiver is granted under Subsection (7), the insurer may:
116 (a) continue to offer autism coverage under the existing plan until the next renewal
117 period for the plan, at which time the insurer:
118 (i) may delete the autism coverage from the plan without having to re-apply for the
119 waiver under Subsection (7); and
120 (ii) file the plan with the commissioner in accordance with guidelines issued by the
121 commissioner;
122 (b) discontinue offering plans subject to Subsection (2), no earlier than the next
123 calendar quarter following the date the waiver is granted, subject to filing guidelines issued by
124 the commissioner; or
125 (c) nonrenew existing plans that are subject to Subsection (2), in compliance with
126 Subsection 31A-22-618.6(5) or Subsection 31A-22-618.7(3).
127 [
128 Section 2. Section 63I-1-231 is amended to read:
129 63I-1-231. Repeal dates, Title 31A.
130 (1) Section 31A-2-217, Coordination with other states, is repealed July 1, 2023.
131 (2) Section 31A-22-615.5 is repealed July 1, 2022.
132 (3) Section 31A-22-619.6, Coordination of benefits with workers' compensation
133 claim--Health insurer's duty to pay, is repealed on July 1, 2018.
134 [
135
Bill Status / Votes
• Senate Actions • House Actions • Fiscal Actions • Other Actions
| Date | Action | Location | Vote |
| 12/12/2017 | Bill Numbered but not Distributed | Legislative Research and General Counsel | |
| 12/15/2017 | Numbered Bill Publicly Distributed | Legislative Research and General Counsel | |
| 12/15/2017 | LFA/ bill sent to agencies for fiscal input | Legislative Research and General Counsel | |
| 12/15/2017 | LFA/ fiscal note publicly available | Legislative Research and General Counsel | |
| 1/11/2018 | House/ received bill from Legislative Research | Clerk of the House | |
| 1/11/2018 | House/ received fiscal note from Fiscal Analyst | Clerk of the House | |
| 1/22/2018 | House/ 1st reading (Introduced) | House Rules Committee | |
| 1/22/2018 | House/ Rules to 3rd Reading Calendar | House 3rd Reading Calendar for House bills | |
| 1/22/2018 | House/ 2nd reading | House 3rd Reading Calendar for House bills | |
| 1/23/2018 (11:20:55 AM) | House/ 3rd reading | House 3rd Reading Calendar for House bills | |
| 1/23/2018 (11:24:01 AM) | House/ passed 3rd reading | Senate Secretary | 58 14 3 |
| 1/23/2018 (11:24:03 AM) | House/ to Senate | Senate Secretary | |
| 1/24/2018 | Senate/ received from House | Waiting for Introduction in the Senate | |
| 1/24/2018 | Senate/ 1st reading (Introduced) | Senate Rules Committee | |
| 1/26/2018 | Senate/ to standing committee | Senate Business and Labor Committee | |
| 1/30/2018 | Senate Comm - Favorable Recommendation | Senate Business and Labor Committee | 6 0 2 |
| 1/31/2018 (11:18:00 AM) | Senate/ committee report favorable | Senate Business and Labor Committee | |
| 1/31/2018 (11:18:01 AM) | Senate/ placed on 2nd Reading Calendar | Senate 2nd Reading Calendar | |
| 2/7/2018 (11:56:39 AM) | Senate/ 2nd reading | Senate 2nd Reading Calendar | |
| 2/7/2018 (11:58:46 AM) | Senate/ passed 2nd reading | Senate 3rd Reading Calendar | 26 0 3 |
| 2/8/2018 (11:27:25 AM) | Senate/ 3rd reading | Senate 3rd Reading Calendar | |
| 2/8/2018 (11:29:20 AM) | Senate/ passed 3rd reading | Senate President | 26 0 3 |
| 2/8/2018 (11:29:21 AM) | Senate/ signed by President/ returned to House | House Speaker | |
| 2/8/2018 (11:29:22 AM) | Senate/ to House | House Speaker | |
| 2/8/2018 | House/ received from Senate | House Speaker | |
| 2/8/2018 | House/ signed by Speaker/ sent for enrolling | Legislative Research and General Counsel / Enrolling | |
| 2/8/2018 | Bill Received from House for Enrolling | Legislative Research and General Counsel / Enrolling | |
| 2/8/2018 | Draft of Enrolled Bill Prepared | Legislative Research and General Counsel / Enrolling | |
| 3/13/2018 | Enrolled Bill Returned to House or Senate | Clerk of the House | |
| 3/13/2018 | House/ enrolled bill to Printing | Clerk of the House | |
| 3/14/2018 | House/ received enrolled bill from Printing | Clerk of the House | |
| 3/14/2018 | House/ to Governor | Executive Branch - Governor | |
| 3/19/2018 | Governor Signed | Lieutenant Governor's office for filing |
Committee Hearings/Floor Debate
- Committee Hearings